Provider Demographics
NPI:1851470306
Name:GUPTA, SHOBHIT (RPH)
Entity type:Individual
Prefix:MR
First Name:SHOBHIT
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 MONTEREY DR NE
Mailing Address - Street 2:APTT # 204 ,
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-7578
Mailing Address - Country:US
Mailing Address - Phone:813-598-3084
Mailing Address - Fax:
Practice Address - Street 1:995 FELLSMERE ROAD , UNIT B
Practice Address - Street 2:
Practice Address - City:SEBASTIAN,FL
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-388-4636
Practice Address - Fax:772-388-3032
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist